Provider First Line Business Practice Location Address:
USAMEDDAC
Provider Second Line Business Practice Location Address:
2480 LLEWELLYN AVE
Provider Business Practice Location Address City Name:
FORT GEORGE G MEADE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-623-4483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2007